Citation Nr: 9928145
Decision Date: 09/29/99 Archive Date: 10/12/99
DOCKET NO. 98-15 460 ) DATE
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On appeal from the
Department of Veterans Affairs Regional Office in St. Louis,
Missouri
THE ISSUE
Entitlement to an increased rating for hemorrhoids, currently
evaluated as 10 percent disabling.
REPRESENTATION
Appellant represented by: Missouri Veterans Commission
WITNESS AT HEARING ON APPEAL
Appellant
ATTORNEY FOR THE BOARD
Robert E. P. Jones, Counsel
INTRODUCTION
The veteran served on active duty from December 1962 to
October 1963. This matter is before the Board of Veterans'
Appeals (Board) on appeal from a December 1997 rating
decision by the Department of Veterans Affairs (VA) Regional
Office (RO) in St. Louis, Missouri.
FINDINGS OF FACT
1. All relevant evidence necessary for an equitable
disposition of the veteran's appeal has been obtained by the
RO.
2. The veteran has internal and external hemorrhoids which
result in intermittent bleeding and discomfort; neither
anemia nor fissures are shown.
CONCLUSION OF LAW
The criteria for an increased rating for hemorrhoids have not
been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R.
§§ 4.7, 4.114, Diagnostic Code 7336 (1998).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
The Board finds that the veteran's claim for an increased
rating for hemorrhoids is well grounded within the meaning of
38 U.S.C.A. § 5107(a). The Board is satisfied that all
relevant facts have been properly developed and that no
further assistance to the veteran is required to comply with
the duty to assist mandated by 38 U.S.C.A. § 5107(a).
In accordance with 38 C.F.R. §§ 4.1, 4.2 (1998) and Schafrath
v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed
all evidence of record pertaining to the history of the
service-connected disability. The Board has found nothing in
the historical record which would lead to the conclusion that
the current evidence of record is not adequate for rating
purposes. Moreover, the Board is of the opinion that this
case presents no evidentiary considerations which would
warrant an exposition of remote clinical histories and
findings pertaining to the service-connected disability,
except as noted below.
Disability ratings are determined by applying the criteria
set forth in the VA Schedule for Rating Disabilities (Rating
Schedule), found in 38 C.F.R. Part 4 (1998). The Board
attempts to determine the extent to which the veteran's
service-connected disability adversely affects his ability to
function under the ordinary conditions of daily life, and the
assigned rating is based, as far as practicable, upon the
average impairment of earning capacity in civil occupations.
38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1998).
Where there is a question as to which of two evaluations
should be applied, the higher evaluation will be assigned if
the disability picture more nearly approximates the criteria
required for that rating. Otherwise, the lower rating will
be assigned. 38 C.F.R. § 4.7.
The veteran submitted a claim for a compensable rating for
hemorrhoids in June 1997. By rating action in February 1999
the veteran was granted a 10 percent rating for this
disability effective from June 1997. The veteran maintains
that he is entitled to a rating in excess of 10 percent for
his hemorrhoidal disability.
The veteran was treated for hemorrhoids during service in
early 1963. The veteran did not have hemorrhoids when
examined by a VA physician in February 1964. The veteran
underwent a hemorrhoidectomy at a VA facility in October
1991.
A May 1997 VA record indicates that the veteran complained of
rectal pain. He reported black stools and fresh blood in his
stool twice a month. When the veteran was seen by VA on an
outpatient record in September 1997, he reported intermittent
hematochezia with the most recent episode 1 or 2 months
earlier. The impression included occult gastrointestinal
bleed, likely due to hemorrhoids but rule out colonic
malignancy/polyps. According to an October 1997 VA
colonoscopy report, there was one small +1 internal
hemorrhoid. Also during the colonoscopy an eight cm polyp
was removed. The diagnoses were three external hemorrhoids
and one +1 internal hemorrhoid.
On VA examination in October 1997 the veteran reported that
he had no involuntary bowel movements and he did not need to
use pads. The veteran did complain of daily dark red stools
with small streaks of bright red. The veteran's sphincter
control appeared good and no fecal leakage was noted. There
were no signs of anemia. There was one large external
hemorrhoid which appeared irritated and could cause a small
amount of bleeding, itching and discomfort. There were also
two smaller medium sized external hemorrhoids. The veteran
reported that he had a history of increased problems with
hemorrhoids with any type of lifting and that bleeding
usually occurred daily. He stated that the stool was usually
brown with a small amount of dark red, and a small amount of
bright red within the stool itself.
A July 1998 VA outpatient record notes that the veteran's
complaints included back and rectal pain on coughing. A
September 1998 VA outpatient treatment record notes that the
veteran complained of blood on bowel movement. The
impression was intermittent rectal bleeding, most likely due
to hemorrhoids.
The veteran appeared before a hearing officer at the RO in
February 1999. The veteran testified that he had occasional
large hemorrhoids. They would bleed and he would have to use
the bathtub to calm things down. He stated that sitting a
lot bothered him. He used hemorrhoid medicine, foam inserts
and stool softeners. The veteran testified that he had had a
hemorrhoidectomy in October 1991 and a conloscopic
polypectomy in October 1997. He stated that his only medical
treatment for hemorrhoids was from VA.
The veteran's service-connected hemorrhoids are rated under
the criteria found in 38 C.F.R. § 4.114, Diagnostic Code
7336, pertaining to external or internal hemorrhoids. Under
that code, a 10 percent rating is provided for hemorrhoids
which are large or thrombotic, irreducible, with excessive
redundant tissue, evidencing frequent recurrences, whereas a
20 percent rating is authorized for hemorrhoids with
persistent bleeding and with secondary anemia, or with
fissures.
The record does show the veteran to have recurrent
hemorrhoids and intermittent bleeding. However, the
September 1997 VA examination and the VA outpatient treatment
records have not indicated persistent bleeding. Moreover,
neither anemia nor fissures have been found. . Accordingly,
the disability does not more nearly approximate the schedular
requirements for a 20 percent rating.
In light of the veteran's contentions concerning the impact
of the disability on his ability to obtain substantially
gainful employment, the Board has considered whether the
claim should be referred to the Director of the VA
Compensation and Pension Service for extra-schedular
consideration under 38 C.F.R. § 3.321(b)(1) (1998). The
Board notes that the veteran has not required frequent
hospitalization for the disability and that the record
reflects that the manifestations of the disability are those
contemplated under the schedular criteria. In sum, there is
no indication that the average industrial impairment from the
disability, as opposed to the veteran's individual industrial
impairment from the disability, would be in excess of that
contemplated by the assigned evaluation of 10 percent.
Therefore, the Board has determined that referral of the
claim for extra-schedular consideration is not in order.
ORDER
Entitlement to an increased rating for hemorrhoids is denied.
SHANE A. DURKIN
Member, Board of Veterans' Appeals